Is a Spreader Graft Necessary to Fix Nasal Valve Collapse?

The question you ask is simultaneously both simple and complicated. The essential truth is that both grafts will help with correction of a crooked nose and both will help with functional problems. However, there are subtle differences between the 2 options.

Difference #1: Approach

I do spreader grafts through a closed approach typically, but many surgeons will only place them using an open approach. If an open approach seems like too much surgery for a single graft, then many surgeons will use an onlay graft instead, which can always be done closed and is technically much simpler.

Difference # 2: Airway affect

If your nasal sidwall collapses when you inspire, then too much cartilage was removed at the first surgery and you probably need an onlay graft more than a spreader graft. A spreader graft will lift and support the cartilage but not strengthen it.  An onlay graft will add strength to the underlying cartilage that is weak by helping to stiffen the sidewall. Conversely, if your valve is narrow but not collapsing, a spreader graft is a better choice becuase it actually lateralizes the canopy cartilage, opening up the airway. In more extreme deviations with collapse, I will often use both a spreader and an onlay.

Difference # 3: Cosmetic effect

A spreader graft will give more subtle deviation correction and it tends to add width only paradorsally (that is closer to the center of the profile). I personally like this cosmetic effect more than the effect you see with onlay grafts. Onlay grafts add width in the entire nasal sidewall, which results in a slightly wider looking nose with less shadow contrast. However, for more extreme nasal deviations, onlay grafts give bigger corrections and are a little more predictable. Again, sometimes I will use both in a single patient.

 

Besides these differences, there are other technical ones that are less important, such as donor cartilage availability and swelling after surgery. All in all, neither is a bad choice. If you are using a reputable surgeon with a good track record of success, then follow their suggestion, as it is probably based on their impression from your examination.

Best of luck

Spreader grafts are commonly used for internal nasal obstruction secondary to internal nasal valve narrowing/collapse.  Most rhinoplasty surgeons would discuss this option with you and explain why they would or would not choose this approach.  Depending on your nasal anatomy, there may be other options.

My recommendation would be to discuss all options with your facial plastic surgeon for a better understanding of the best approach for your nose.

Spreader grafts may be harvested from nasal septal cartilage and are useful for both functional and aesthetic nasal concerns. These small pieces of cartilage may be 10 x 3 mm, and are typically sutured to the top of your septum to move your upper lateral cartilage outward - this may lead to a straighter nasal appearance and improved breathing. Hope this helps. Dr Joseph

In most cases, a spreader graft is not needed in primary rhinoplasty. However, I usually use it to correct internal nasal valve collapse after secondary rhinoplasty. It is also indicated for the deviated nose as well as correction of functional deformity from a secondary rhinoplasty, or if you want to widen the dorsal aesthetic lines. In most primary rhinoplasty patient cases, it is not necessary and does create a wider dorsum which is aesthetically unpleasing.

A collapsed internal nasal valve is often repaired with a spreader graft. I personally place these with and external approach but it can be done closed as well. A batten graft may be used as well. These are usuallly used to repair an external valve collapse. The terminology can be confusing and the surgery is quite specialized. If your surgeon is experienced trust their recommendation.

It appears that you may have had some collapse of your internal nasal valve after the initial surgery.  However, nasal airway obstruction may be due to a number of causes.  A deviated septum, enlarged turbinates, or valve collapse are all culprits of poor nasal breathing.  It is important to obtain a thorough exam by a rhinoplasty specialist to determine the cause of your poor nasal function. 

Spreader grafts can help internal nasal valve collapse.  However, there are a number of other grafts that can also improve the internal valve such as splay grafts, butterfly grafts, etc.  The type of graft used will depend on the remaining cartilage (septum, ear, etc) that may be available, the comfort level of that surgeon with that technique, and the severity of the valve collapse.  The external nasal valve should also be thoroughly evaluated to assure this does not also need to be addressed.

There are many ways to improve breathing when the cause is pinching or narrowing of the side walls of the nose. Spreader grafts are thin slivers of cartilage placed or sutured between the edge of the septum just below the skin and the flat cartilaginous plate supporting the side wall of the nose. Although spreader grafts are popular, they are not the only way. It is far easier to place them using an open approach. This is complicated surgery and you should get a second opinion.

Hi 11704 in Lindenhurst,

Rhinoplasty has many potential maneuvers to achieve desired results. In addition, every surgeon has different methods to accomplish the goal. Spreader grafts are commonly used to improve a narrowed internal angle. Spreader grafts may be placed via an endonasal (closed) approach, however, I think most rhinoplasty surgeons use an open approach. Your rhinoplasty surgeon may want to place alternate grafts to improve your nasal breathing and appearance, such as alar batten grafts. Rhinoplasty grafts may also improve the asymmetry or crookedness of the nose.

Only after a comprehensive evaluation can a rhinoplasty surgeon help determine appropriate options for you. Best of luck.

Dr. Chaboki

Spreader grafts are grafts from septal cartilage or less commonly ear or rib cartilage which are placed between the upper lateral cartilage and the septum to widen the nasal valve.   This can improve breathing and also widen this area if there is a visible depression.   Spreader grafts can also help to straighten a crooked septum that has a high deviation and make the nose  straighter.   Alar batten grafts are grafts placed under the lateral crura to add more rigidity to this area if it is weakened (by surgery or naturally) and prevent collapse with inspiration.   Perhaps your surgeon is referring to this approach to fixing your nasal valve.  Most would agree the open approach is preferred in revision rhinoplasty but many surgeons also perform revisions closed.   It sounds like you need to have another discussion with your surgeon to get some of your questions answered. 

Spreader grafts are great for preventing the middle part of the nose from becoming too narrow. I also feel that in most patients, spreader grafts also help improve the patient's breathing. However, some surgeons feel that butterfly grafts are more effective in preventing internal nasal valve collapse. I am not one of those surgeons, but most likely yours is. Regarding a crooked nose, neither graft will correct a crooked nose unless the graft is placed assymetrically or only on one side. Ultimately, if your surgeon is an experienced rhinoplasty expert, I'm sure you are in good hands.

Andrew C. Campbell, M.D.

Board Certified Facial Plastic Surgeon

It's a not uncommon scenerio for a patient with a nasal hump reduction to eventually develope internal valve collapse in the middle third of their nose if a spreader graft isn't placed at the time of surgery.

A spreader graft can be placed secondarily, like in your case, during a separate procedure if needed. There are other types of grafts or sutures that some use to help with valve collapse. It may help if the surgeon you spoke with explained what he was planning on doing more precisely.

Improving the narrowing in the middle third of the nose can improve the symmetry of the nose as well. The shadowing that the collapse creates can cause the nose to look crooked.